LAFOLLETTE MEDICAL FOUNDATION INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- LAFOLLETTE MEDICAL FOUNDATION INC (EIN 20-4901729)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-09-21
- IRS object ID
- 201632659349300613
- Schema version
- 2015v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-09-21T08:49:44-05:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 621142155 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PUGH & COMPANY PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 315 N CEDAR BLUFF RD SUITE 200 | AddressLine1Txt |
| City | KNOXVILLE | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37923 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 204901729 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAFOLLETTE MEDICAL FOUNDATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LAFO | BusinessNameControlTxt |
| Phone | 4239126963 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 128 | AddressLine1Txt |
| City | JACKSBORO | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37757 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DR JAMES FARRIS | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 4239126963 | PhoneNum |
| Signature | 2016-08-18 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | RE FOUST | PreparerPersonNm |
| PTIN | P00745365 | PTIN |
| Phone | 8657690660 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DR JAMES FARRIS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 128 | AddressLine1Txt |
| City | JACKSBORO | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37757 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $9,945,616 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.LAFOLLETTEMEDICALFOUNDATION.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2006 | FormationYr |
| Legal Domicile State | TN | LegalDomicileStateCd |
| Activity Or Mission | TO SUPPORT ORGANIZATIONS THAT PROVIDE FOR THE HEALTHCARE OF THE LAFOLLETTE COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $937,863 | PYInvestmentIncomeAmt |
| CY Investment Income | $861,511 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $937,863 | PYTotalRevenueAmt |
| CY Total Revenue | $861,511 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $453,079 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $550,173 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $146,453 | PYOtherExpensesAmt |
| CY Other Expenses | $119,298 | CYOtherExpensesAmt |
| PY Total Expenses | $599,532 | PYTotalExpensesAmt |
| CY Total Expenses | $669,471 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $338,331 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $192,040 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $10,306,860 | TotalAssetsBOYAmt |
| Total Assets EOY | $9,577,759 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $34,450 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $46,200 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $10,272,410 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,531,559 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | LAFOLLETTE MEDICAL FOUNDATION, INC. ("THE FOUNDATION") IS ORGANIZED AS A PUBLIC BENEFIT CORPORATION FOR THE CHARITABLE PURPOSE OF MAKING DISTRIBUTIONS TO QUALIFYING 501(C)(3) ORGANIZATIONS THAT PROVIDE FOR THE HEALTHCARE OF THE RESIDENTS OF LAFOLLETTE COMMUNITY, WHICH INCLUDES ALL OF CAMPBELL COUNTY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $550,173 | ExpenseAmt |
| Grant | $550,173 | GrantAmt |
| Desc | DURING 2015, THE ORGANIZATION CONTINUED TO CARRY-OUT IT'S EXEMPT MISSION BY ALLOCATING $550,173 IN GRANTS TO ORGANIZATIONS TO IMPROVE THE HEALTH AND QUALITY OF LIFE FOR PEOPLE IN THE LAFOLLETTE AREA AND IN THE COMMUNITY OF CAMPBELL COUNTY, TENNESSEE. | Desc |
| Total Program Service Expenses | $550,173 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | TN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JUNE WILBURN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4239126963 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 905 RIVERVIEW DRIVE | AddressLine1Txt |
| City | LAFOLLETTE | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37766 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (7 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|
| BRENDA ROBARDS | |||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 |
| MAYOR MIKE STANFIELD | |||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 |
| LUCY LOBERTINI | |||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 |
| KATHY MYERS | |||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 |
| JUDGE SHAYNE SEXTON | |||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 |
| ELIZABETH ASBURY | |||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 |
| DR JAMES FARRIS | |||||
| PRESIDENT AND CHAIRMAN | 1.00 | Yes (X) | $0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $237,983 | TotalRevenueColumnAmt |
| Exclusion | $237,983 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $9,707,633 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $9,084,105 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $623,528 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $623,528 | TotalRevenueColumnAmt |
| Exclusion | $623,528 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $861,511 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $861,511 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $550,173 | TotalAmt |
| Program Services | $550,173 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,334 | TotalAmt |
| Management And General | $5,334 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,876 | TotalAmt |
| Management And General | $14,876 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73,104 | TotalAmt |
| Management And General | $73,104 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,000 | TotalAmt |
| Management And General | $15,000 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,248 | TotalAmt |
| Management And General | $9,248 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,736 | TotalAmt |
| Management And General | $1,736 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $669,471 | TotalAmt |
| Program Services | $550,173 | ProgramServicesAmt |
| Management And General | $119,298 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $685,107 | BOYAmt |
| EOY | $389,430 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,621,753 | BOYAmt |
| EOY | $9,188,329 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,306,860 | BOYAmt |
| EOY | $9,577,759 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,450 | BOYAmt |
| EOY | $46,200 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,450 | BOYAmt |
| EOY | $46,200 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,272,410 | BOYAmt |
| EOY | $9,531,559 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,272,410 | BOYAmt |
| EOY | $9,531,559 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,306,860 | BOYAmt |
| EOY | $9,577,759 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $192,040 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$932,891 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,498,158 | CurrentTaxYearMinus4YearsAmt |
| Total | $1,498,158 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,498,158 | CurrentTaxYearMinus4YearsAmt |
| Total | $1,498,158 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $1,498,158 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $260,522 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $279,611 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $277,932 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $328,661 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $237,983 | CurrentTaxYearAmt |
| Total | $1,384,709 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $2,882,867 | TotalSupportAmt |
| Public Support CY170 | 0.51970 | PublicSupportCY170Pct |
| Public Support PY170 | 0.51720 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | -$144,484 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$932,891 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$932,891 | RevenueNotReportedAmt |
| Revenue Subtotal | $788,407 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $73,104 | InvestmentExpensesNotIncldAmt |
| Revenue Not Reported Fincl Stmt | $73,104 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $861,511 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $596,367 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $596,367 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $73,104 | InvestmentExpensesNotIncld2Amt |
| Expenses Not Rpt Fincl Stmt | $73,104 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $669,471 | TotalExpensesPerForm990Amt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (13 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| THE SHEPHERD'S HOME INC | |||||||
| P O BOX 707 | JACKSBORO | TN | 37757 | 270988603 | 501(C)(3) | $60,000 | CAMPBELL COUNTY FIRST WOMEN'S TRANSITIONAL HOME |
| FOOD LIFE SERVICES OF CAMPBELL COUNTY | |||||||
| 206 S INDIANA AVE | LAFOLLETTE | TN | 37766 | 621812105 | 501(C)(3) | $60,000 | EXPANDED NUTRITIONAL DISTRIBUTION |
| CAMPBELL COUNTY SENIOR CITIZENS | |||||||
| 102 8TH STREET | LAFOLLETTE | TN | 37766 | 620988347 | 501(C)(3) | $59,892 | HOME DELIVERED MEALS FOR ELIGIBLE SENIORS |
| CAMPBELL COUNTY CHILDREN'S CENTER | |||||||
| 203 INDEPENDENCE LN | LAFOLLETTE | TN | 37766 | 113820921 | 501(C)(3) | $49,000 | HEALTH EDUCATION/PREVENTION PROGRAM |
| COMMUNITY HEALTH OF EAST TENNESSEE | |||||||
| P O BOX 209 507 MAIN ST | JACKSBORO | TN | 37757 | 581470587 | 501(C)(3) | $79,138 | DRUG COURT PROGRAM |
| TN BAPTIST ADULT HOMES | |||||||
| PO BOX 728 | BRENTWOOD | TN | 37024 | 620934533 | 501(C)(3) | $28,000 | RAINBOW ACRES, JACKSBORO RESIDENT HARDSHIP & WELLNESS |
| CASA OF CAMPBELL COUNTY | |||||||
| PO BOX 1054 | JACKSBORO | TN | 37757 | 205755609 | 501(C)(3) | $13,000 | VOLUNTEER OUTREACH SERVICES |
| CATHOLIC CARITIES OF EAST TENNESSEE | |||||||
| 3009 LAKE BROOK BLVD | KNOXVILLE | TN | 37909 | 621377551 | 501(C)(3) | $12,000 | PREGNANCY HELP CENTER |
| CAMPBELL COUNTY BOARD OF EDUCATION | |||||||
| 172 VALLEY ST | JACKSBORO | TN | 37757 | 606000507 | GOVERMENT AGENCY | $74,518 | 2014 INFLUENZA VACCINATION PROGRAM; JELLICO HIGH SCHOOL ATHLETIC PERSONAL TRAINER |
| SPRINGS OF LIFE RECOVERY CENTER | |||||||
| 185 BAKER ST | JELLICO | TN | 37762 | 464828906 | 501(C)(3) | $71,200 | RESTORING HOPE |
| EAST TENNESSEE CHILDREN'S HOSPITAL | |||||||
| 2018 W CLINCH AVE | KNOXVILLE | TN | 37916 | 626002604 | 501(C)(3) | $10,425 | CAR SEAT SAFETY IN CAMPBELL COUNTY |
| EAST TENNESSEE HUMAN RESOURCES AGENCY | |||||||
| 9111 CROSS PARK DR STE D100 | KNOXVILLE | TN | 37923 | 621493851 | 501(C)(3) | $22,000 | SENIOR SAFETY AND WELLNESS SUPPORT |
| CAMPBELL COUNTY EMERGENCY MEDICAL SERVICES | |||||||
| 136 N MASSACHUSETTS AVE | LAFOLLETTE | TN | 37766 | 606000507 | GOVERMENT AGENCY | $11,000 | EDUCATE & VENTILATE CAMPBELL COUNTY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 13 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION GRANTS FUNDS TO SECTION 501(C)(3) AND GOVERNMENT ORGANIZATIONS WHOSE PURPOSE IS IN LINE WITH THAT OF THE ORGANIZATION. THE ORGANIZATION REQUIRES MID-GRANT REPORTS AND EXIT REPORTS FROM GRANTEES REGARDING THEIR USE OF GRANT FUNDS. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE ORGANIZATION'S FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM AND MADE AVAILABLE TO ALL MEMBERS OF THE BOARD PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION'S CONFLICT OF INTEREST POLICY REQUIRES THE BOARD TO REVIEW THE POLICY AND SIGN AN ANNUAL STATEMENT TO ACKNOWLEDGE THEIR UNDERSTANDING OF THE POLICY. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES IT GOVERNING DOCUMENTS, CONFLICT OR INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
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